The use of incisional refractive surgery has become limited due to the widespread use of the excimer laser to correct myopia, hyperopia and astigmatism. Laser in situ keratomileusis and photorefractive keratectomy have proven to be much more accurate and predictable in correcting refractive error. This has made some forms of incisional refractive surgery practically obsolete. Radial keratotomy should not be considered a primary refractive procedure in the modern world, as RK has become "RKhaic". There are still indications for incisional refractive surgery in cataract and post-surgical patients for the treatment of astigmatism. However, with the advent of the toric intraocular lens and the use of LASIK in such aforementioned patients, these indications for incisional surgery will likely become more limited. In this review, we go over the past history of incisional refractive surgery and also report the current uses and advancements of this technique in today's practice environment.